PURPOSE: : For patients treated with palliative radiation, we examined the association between life expectancy predictions by radiation oncologists and aggressive end-of-life care. MATERIALS AND METHODS: : We included decedents from a study that assessed the ability of oncologists to predict survival of patients with metastatic cancer who received radiation. We identified patients who died within 12 months of study enrollment to assess accuracy of predictions. Aggressive end-of-life care was defined by the National Quality Forum, ASCO Quality Oncology Practice Initiative metrics, and advanced radiation modalities in the last month of life. Survival predictions were categorized as follows: correct (< 12 months), 12 to 18 months, 18 to 24 months, and more than 24 months. We assessed association between prediction and aggressive end-of-life care using a generalized estimation equation. RESULTS: : Of 489 decedents, we identified 467 encounters with survival estimates. Overall, 156 decedents (32%) met at least one metric of aggressive end-of-life care. Factors associated with aggressive end-of-life care included younger age, female sex, primary cancer diagnosis, no brain metastases, and private insurance. In each encounter when an oncologist predicted survival, 363 predictions (78%) were correct (< 12 months), 54 (11%) incorrectly predicted 12 to 18 months, 27 (6%) predicted 18 to 24 months, and 23 (5%) predicted more than 24 months. Compared with patients who had encounters that had correct survival predictions, patients predicted to live more than 24 months were more likely to meet at least one metric of aggressive end-of-life care (odds ratio, 2.55; 95% CI, 1.09 to 5.99; P = .03). CONCLUSION: : Inaccurate survival predictions by oncologists are associated with more aggressive end-of-life care for patients with advanced cancer.
PURPOSE: : For patients treated with palliative radiation, we examined the association between life expectancy predictions by radiation oncologists and aggressive end-of-life care. MATERIALS AND METHODS: : We included decedents from a study that assessed the ability of oncologists to predict survival of patients with metastatic cancer who received radiation. We identified patients who died within 12 months of study enrollment to assess accuracy of predictions. Aggressive end-of-life care was defined by the National Quality Forum, ASCO Quality Oncology Practice Initiative metrics, and advanced radiation modalities in the last month of life. Survival predictions were categorized as follows: correct (< 12 months), 12 to 18 months, 18 to 24 months, and more than 24 months. We assessed association between prediction and aggressive end-of-life care using a generalized estimation equation. RESULTS: : Of 489 decedents, we identified 467 encounters with survival estimates. Overall, 156 decedents (32%) met at least one metric of aggressive end-of-life care. Factors associated with aggressive end-of-life care included younger age, female sex, primary cancer diagnosis, no brain metastases, and private insurance. In each encounter when an oncologist predicted survival, 363 predictions (78%) were correct (< 12 months), 54 (11%) incorrectly predicted 12 to 18 months, 27 (6%) predicted 18 to 24 months, and 23 (5%) predicted more than 24 months. Compared with patients who had encounters that had correct survival predictions, patients predicted to live more than 24 months were more likely to meet at least one metric of aggressive end-of-life care (odds ratio, 2.55; 95% CI, 1.09 to 5.99; P = .03). CONCLUSION: : Inaccurate survival predictions by oncologists are associated with more aggressive end-of-life care for patients with advanced cancer.
Authors: Christopher R Manz; Ravi B Parikh; Chalanda N Evans; Corey Chivers; Susan H Regli; Justin E Bekelman; Dylan Small; Charles A L Rareshide; Nina O'Connor; Lynn M Schuchter; Lawrence N Shulman; Mitesh S Patel Journal: Contemp Clin Trials Date: 2020-01-23 Impact factor: 2.226
Authors: Michael F Gensheimer; Sonya Aggarwal; Kathryn R K Benson; Justin N Carter; A Solomon Henry; Douglas J Wood; Scott G Soltys; Steven Hancock; Erqi Pollom; Nigam H Shah; Daniel T Chang Journal: J Am Med Inform Assoc Date: 2021-06-12 Impact factor: 4.497
Authors: Kea Turner; Naomi C Brownstein; Zachary Thompson; Issam El Naqa; Yi Luo; Heather S L Jim; Dana E Rollison; Rachel Howard; Desmond Zeng; Stephen A Rosenberg; Bradford Perez; Andreas Saltos; Laura B Oswald; Brian D Gonzalez; Jessica Y Islam; Amir Alishahi Tabriz; Wenbin Zhang; Thomas J Dilling Journal: Radiother Oncol Date: 2021-12-23 Impact factor: 6.280
Authors: Adrianna E Mojica-Márquez; Joshua L Rodríguez-López; Ankur K Patel; Diane C Ling; Malolan S Rajagopalan; Sushil Beriwal Journal: Cancer Med Date: 2020-06-26 Impact factor: 4.452
Authors: Samuel U Takvorian; Justin Bekelman; Rinad S Beidas; Robert Schnoll; Alicia B W Clifton; Tasnim Salam; Peter Gabriel; E Paul Wileyto; Callie A Scott; David A Asch; Alison M Buttenheim; Katharine A Rendle; Krisda Chaiyachati; Rachel C Shelton; Sue Ware; Corey Chivers; Lynn M Schuchter; Pallavi Kumar; Lawrence N Shulman; Nina O'Connor; Adina Lieberman; Kelly Zentgraf; Ravi B Parikh Journal: Implement Sci Date: 2021-09-25 Impact factor: 7.327